Urinary problems

Some treatments for prostate cancer can cause problems passing urine. These can include:

  • leaking urine (incontinence) which can range from leaking a few drops to leaking in a lot during the day and night
  • leaking or dribbling urine when you sneeze, cough or exercise (stress incontinence)
  • passing urine more often than usual (more than eight times a day)
  • getting up a lot at night to pass urine (nocturia) 
  • needing to go to the toilet urgently (urgency), and sometimes leaking before you get there (urge incontinence) 
  • a weaker or slower flow of urine, or
  • problems emptying your bladder (urine retention).

There are treatments and lifestyle changes that can help manage or even stop these problems.

Urinary problems can also be caused by an enlarged prostate, also called a benign prostatic enlargement or BPE. And urine infections can cause symptoms such as needing to pass urine more often and without much warning, a burning feeling and cloudy, dark or strong smelling urine.

This page does not describe the signs and symptoms of prostate cancer.

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Which treatments cause urinary problems?

The following prostate cancer treatments may cause urinary problems:

If you are considering which treatment to have for prostate cancer, discuss the possible side effects with your doctor. You can also speak to one of our specialist nurses by calling our Helpline.

Watch Paul's story for one man's experience of managing urinary problems after prostate cancer treatment:

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What help is there for urinary problems?

Let your doctor or nurse know if you have any urinary problems. They will be able to offer advice about treatment, and may refer you to an NHS continence service. These are run by nurses and physiotherapists who specialise in urinary problems. Your GP can also refer you to a continence service.

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What can I do to help myself?

Making changes to your lifestyle may help.

  • Drink plenty of fluids (one and a half to two litres or three to four pints per day). But avoid or reduce fizzy drinks, drinks that contain caffeine (tea, coffee and cola), and alcohol.
  • Regular pelvic floor muscle exercises can help strengthen your pelvic floor muscles. These muscles control urination.

These changes will help to reduce pressure on your pelvic floor muscles.

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Urinary catheters

A urinary catheter is a narrow tube which is passed through your penis into the bladder, or through a small cut in your abdomen (a suprapubic catheter). It drains urine out of the body. You may have a catheter for a short time after some treatments for prostate cancer, including surgery, cryotherapy and HIFU. You may also use a catheter if you have problems emptying your bladder (urine retention).

Your nurse will show you how to use a catheter and how to look after it. They will show you how to:

  • empty the bag and how often
  • connect a larger bag at night
  • clean the catheter, and
  • get a prescription for more supplies.

Urine infections can be common if you have a catheter. To help prevent infection:

  • wash your hands before and after handling your catheter
  • wash the area where the catheter enters the body every
  • drink plenty of fluids
  • eat plenty of fibre to avoid constipation
  • let your nurse know if the catheter is not draining properly, and
  • contact your doctor or nurse if you have any signs of a urine infection.

Watch Paul talk about having an external catheter.

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What if I leak urine?

You may leak urine because you have a problem with your bladder, sphincter or pelvic floor muscles. Some men also leak urine when they are sexually aroused or during sex.

There are a number of things that may help:

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What if I dribble after I finish passing urine?

Losing a few drops after you have finished passing urine is common in all men, but is more likely if the pelvic floor muscles are weak.

After you have finished passing urine, try tightening your pelvic floor muscles once for several seconds or tightening and releasing them a few times. This will push any remaining urine out of the urethra and help stop the dribbling.

Or, wait a few seconds after you have finished passing urine and then press gently behind the scrotum. Move your fingers forward towards the base of the penis under the scrotum. This should push the urine along the urethra and you can shake out the last few drops.

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What if I pass urine frequently and with little warning?

Some men need to pass urine more often and have a sudden urge to go to the toilet. Sometimes they may leak before they get there. This may be due to the bladder muscles contracting to push urine out before you are ready.

There are a number of things you can do to help:

  • drink plenty of fluids - do not reduce your fluid intake as this can make symptoms worse
  • avoid drinks that might irritate the bladder such as fizzy drinks, drinks containing caffeine such as coffee, tea and cola, and alcohol.
  • pelvic floor muscle exercises
  • bladder retraining
  • medicines
  • a treatment called Stoller Afferent Nerve Stimulation (SANS) , and
  • botox.

If you need to urinate frequently and notice that your urine is dark, cloudy, smells or stings, you may have a urine infection and should go and see your GP.

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What if I get up to pass urine a lot at night?

If you have to get up to go to the toilet a lot at night, try cutting down on any drinks in the last two hours before you go to bed, particularly any alcohol, coffee or tea. Bladder retraining may help, but you will need to train your bladder in the daytime before you work on any problems at night.

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What if I have problems emptying my bladder?

If your urethra becomes very narrow, you may not be able to empty your bladder. Prostate cancer, some treatments for prostate cancer, or other prostate problems such as non-cancerous benign prostatic enlargement (BPE) can all cause this.

If you have a sudden and painful inability to pass urine (acute urinary retention) it is important that you get treatment straight away. You should contact your doctor or nurse, or go to your hospital's accident and emergency (A&E) department. They may need to drain your bladder using a catheter.

Some men may be able to pass some urine but leave more and more behind in the bladder (chronic retention). Signs may include leaking urine, wetting the bed, discomfort in your abdomen or increased urine infections. You may need to pass urine more frequently or urgently, your bladder still feels full or your stream is weak.

Let your doctor or nurse know if you are having any of these problems. Chronic retention is usually painless but it means that you are not passing all of the urine. Your bladder slowly stretches, which can weaken the bladder muscle. The urine left in your bladder may cause an infection or bladder stones. Without treatment, the build up of urine can overwork the kidneys and cause them to fail.

There are several treatments that can help.

  • Medication can relax the muscles at the neck of the bladder or shrink the prostate.
  • You may be able to self-catheterise.
  • Some men may need a long-term catheter fitted through a small cut in their abdomen.
  • An operation may help to widen the urethra.

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Where can I get support?

Urinary problems can affect your self-esteem and your independence. There is support available.

Your GP, continence nurse or specialist nurse will be able to offer you practical and emotional support. The Bladder and Bowel Foundation can also provide information. The manufacturers of continence products may offer advice about using their products.

You may find it helpful to speak to our support volunteers who are all personally affected by prostate cancer.

There are also prostate cancer support groups throughout the country where you and your family can meet other people affected by prostate cancer. Some continence services also run local support groups.

And you can join our online community.

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Questions to ask your doctor or nurse

  • Is the treatment I am having for prostate cancer likely to cause any urinary problems?
  • What type of urinary problems might I have?
  • If I cannot pass urine what should I do?
  • Will my urinary problems get better?
  • What treatment is available?
  • What else can I do to help myself?
  • What are the risks and side effects of treatments for urinary problems?
  • Where can I get pads and other equipment?

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References

You can find a full list of references used to produce this page in our online fact sheet.